UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #11

[esther43]

Can you explain to me where you are going with this line of questioning?



I'm going disclaim once again that I have not undergone the verified expert process, therefore you should not regard anything I have to say as anything but my opinion.

Back in 1989, without surfactant, preemie lungs were very stiff and hard to keep open. To help them, very very high ventilator pressures were used in combination with a breathing tube. This often led to some pretty serious lung damage, both short and long term. The short term damage included pneumothorax, pulmonary interstitial emphysema, and so on. PVE (the pulmonary vascular embolism) was just one of these complications. In this case, the alveoli rupture which is what allows air to enter circulation. Pneumothorax and PIE still happen at times, but PVE doesn't, presumably because it requires significantly higher pressures to produce. This article describes how the babies it happened to were already incredibly ill, already on maximal ventilator support and 100% oxygen.

The reason why this article is significant is because the researchers had observed so many cases of vascular air embolism in their patients that they were able to describe skin changes that might not always be seen. There is no reason that how the air entered circulation should change how it acts once it is there:

From this article:
"Blanching and migrating areas of cutaneous pallor were noted in several cases and, in one of our own cases we noted bright pink vessels against a generally cyanosed cutaneous background. This we attributed to direct oxygenation of erythrocytes adjacent to free air in the vascular system, while the tissues continued to be poorly perfused and oxygenated."

IMO, CPAP, unless somehow grossly misused, would never cause something like this and a baby would not recover after a mere thirty minutes of resuscitation.

Interesting read and interpretation. I am not medical at all but in trying to understand why some episodes of alleged air embolism were fatal and some non fatal, I wondered if it depended on where in the blood circulatory system the air bubble ended up ? for example if it ended up in the chambers of the heart could it cause cardiac arrest? Then what if resuscitation and ventilation moved the air bubble away from the heart and the vigorous pumping of blood helps to shift it along and eventually cause it to pop?

 

[WaxLyrical]

Dr J didn't do his deep dive research on the AE's until after L and M's cases were over. So I don't see why that should have any impact upon his notes that day?

As to L and M, they were both having sudden, unexpected health issues at the same time. I think that could have an impact upon him. JMO

I think possibly we’re misunderstanding each other. I don’t think AE should have impacted his notes either, clearly since he didn’t research AE until two months later. I think it was a terrible mistake for him not to have noted the strange and fleeting mottling that he’d remarked upon previously.

I think he chose not to note it. I appreciate others disagree. I doubt any of us will ever know the truth. And I don’t think it matters either way.

I interpreted your original comment to mean that Dr J had suggested his reason for not noting the mottling was because he’d been involved in two total collapses in 20 hours. But I’m not sure Dr J had anything to do with Baby L’s blood sugar situation (and nobody realised there had been a poisoning until much later), and I don’t think baby L had what would be described as a ‘collapse’. So if Dr J is saying this, I believe him even less about his reasons for not noting down his observations. JMO.

I think he attempted to explain it by saying there was a lot going on at the time----that was the 2nd baby with an unexplained total collapse within last 20 hours and they were twins.

That is a lot of intense stress and pressure on the medical team. Most of his notes were probably about which emergency medications and treatments were immediately needed. And he would be jotting down vitals and test results too, and anything else coming to mind to save this baby.

He missed making note of the mottling. I don't think that is an earth shattering mistake for an emergency doctor to make. Both babies were brought back from the brink of death, so I do credit the team with that.

 

[magikarpmagikarp]

Interesting read and interpretation. I am not medical at all but in trying to understand why some episodes of alleged air embolism were fatal and some non fatal, I wondered if it depended on where in the blood circulatory system the air bubble ended up for example if it ended up in the chamber's of the heart could it cause cardiac arrest? Then what if resuscitation and ventilation moved the air bubble away from the heart and it's the vigorous pumping of blood that is helping to shift it along and eventually pop?

Air that gets to the capillary bed of the lungs can eventually diffuse out through the alveoli, as long as the blood is moving and air is coming in and out of the lungs. Air embolism causes cardiac arrest by displacing blood which is needed to bring oxygen to the coronary arteries of the heart. Then everything just stops, unless a resuscitation is started. I don't think anyone can say precisely why did one baby survive and not another. IMO, the basic idea though, is that just because someone was able to be revived, it does not mean it wasn't an air embolism. It's what happens before, what happens during the resuscitation, and what happens afterwards that has given a lot of clues to the expert witnesses that caused them to make these conclusions.

 

[katydid23]

I took detailed notes of the timeline given in the newest podcast by Liz Hull.

The Trial

Podcast · [object Object] · The Trial goes behind the headlines of some of the biggest trials in the world. We take you into the courtroom, bringing you the detail as the evidence unfolds, examining key moments and carrying out exclusive interviews with detectives, victims, and experts. Follow...

open.spotify.com

Liz Hull:


Feb 20 edition

11th baby, 1st of twin boys, baby L

April 9th, 2016

Born 7 weeks early

L not growing properly in utero


Before her c-section mum was introduced to LL and another nurse, who would be caring for her twin boys after birth


The boys were healthy and ’nice’ mum said


Dad said Lucy and Laura took his boys to nursery and they were in good condition


L had slightly low blood sugar at birth so Lucy gave him a glucose drip an hour after his birth and after she finished her day shift that day, baby L’s blood sugars normalised


LL was not due to work the next day, which was Saturday—but she volunteered to do an extra shift, as there were 15 babies at the time and they needed the help


A few days earlier, she had moved into a new home


At 7:30 am, on April 9th, LL arrived to her 4th day shift in a row


She wasn’t designated nurse for the twin boys—that was MG—but she did have 2 designated babies in the same room. —room 1


Within hours, of LL's return to work, sugar levels in baby L fell dangerously low


MG asks dr uduko to come look at the levels and he orders glucose drip, cosigned for by LL and MG


@12:30 MG went on lunch break


@ 12:53 LL began text about Grand National bets


@ 1:45 housewarming party group chat invite


Around 2 pm-MG returns —After taking hourly heel prick tests of L’s blood sugar and despite upping the constant glucose drips, he is still getting lower readings


MG was surprised said ‘it was quite a shock —I didn’t expect it would it have fallen even lower”


@3:30 doctors upped glucose drip level once again and a larger blood sample was taken and sent off to Liverpool for specialist testing


This^^^ Liverpool test is central to prosecution case and we will be returning to it later for sure


MG and LL were putting together a NEW bag of the glucose drip for baby L, when they were forced to stop what they were doing because baby M’s monitor was beeping for an emergency just before 4 pm.


---around 4 pm, Baby M had suddenly collapsed and stopped breathing


MG: “LL was with me and his alarm went and she went to check and said yes, he needs help we need to sort it out”


[ I think MG and LL were together by that med station/refrigerator which is in room 1, essentially, putting together that new glucose bag—so LL would just have to hurry a few steps away to get to baby M’s cot]


[Also, just before baby M collapsed at 4 , MG would have been busy conferring with the doctors about baby L’s drop in blood sugar around 3:30—and his new blood test to be drawn up and sent out—— LL had 2 babies in the same room, so while MG was busy LL had easy access to baby M]


The jury is shown a picture of the refrigerator where MG and LL are working together at the time M’s alarm goes off.


And they are reminded that all the nurses have access to the refrigerator keys at any time


After baby M’s collapse, LL goes back to looking after her 2 babies in room 1.


And she receives the text from Mum telling her she won her horse bet for 135 pounds


Despite the increased glucose, L’s sugar remained persistently low/Prosecution accuses LL of injected insulin to the glucose drip to try and kill him


After LL left that night she had a couple of days off. April 10th- A new doctor took over care of baby L, and it was this doctor that caused an emotional reaction from LL in court


On the 10th, under this doctor’s care, Baby L recovered and his sugars stabilised


Dr John Gibbs received test April 14th—and entered it into the file—but he didn’t realise the importance of the test and didn’t yet understand that it meant that the child had been injected with synthetic insulin—it was not his natural body’s reaction shown in that test result

Baby L had not been prescribed insulin. Just like with Baby F …who also received mysterious injection

Defense denies the murder attempt

Meyer says 'there is nothing surprising about such a preterm low weight baby having such low blood sugar, as it is common'

'Nothing to show it was LL'

[ Meyers claims there is nothing to show it was LL---but there are only a couple of people that were working in room 1----so it is narrowed down to LL, MG or the 3rd nurse. Problem for LL is that those other 2 were not around during some of the other incidents, whereas LL was. ]

 

[Kemug]

So - if LL caused AE's in babies, might she not have researched how to do it, and what the effects might be? eg maybe she even found the exact same article which Dr J did? So, wouldn't any searching which LL may have done leave a trail in her computer? Has her computer been thoroughly examined for searches? Has she acquired a new computer since then? My apologies if this has already been discussed.

 

[sapphireminds]

I took detailed notes of the timeline given in the newest podcast by Liz Hull.

The Trial

Podcast · [object Object] · The Trial goes behind the headlines of some of the biggest trials in the world. We take you into the courtroom, bringing you the detail as the evidence unfolds, examining key moments and carrying out exclusive interviews with detectives, victims, and experts. Follow...

open.spotify.com

Liz Hull:


Feb 20 edition

11th baby, 1st of twin boys, baby L

April 9th, 2016

Born 7 weeks early

L not growing properly in utero


Before her c-section mum was introduced to LL and another nurse, who would be caring for her twin boys after birth


The boys were healthy and ’nice’ mum said


Dad said Lucy and Laura took his boys to nursery and they were in good condition


L had slightly low blood sugar at birth so Lucy gave him a glucose drip an hour after his birth and after she finished her day shift that day, baby L’s blood sugars normalised


LL was not due to work the next day, which was Saturday—but she volunteered to do an extra shift, as there were 15 babies at the time and they needed the help


A few days earlier, she had moved into a new home


At 7:30 am, on April 9th, LL arrived to her 4th day shift in a row


She wasn’t designated nurse for the twin boys—that was MG—but she did have 2 designated babies in the same room. —room 1


Within hours, of LL's return to work, sugar levels in baby L fell dangerously low


MG asks dr uduko to come look at the levels and he orders glucose drip, cosigned for by LL and MG


@12:30 MG went on lunch break


@ 12:53 LL began text about Grand National bets


@ 1:45 housewarming party group chat invite


Around 2 pm-MG returns —After taking hourly heel prick tests of L’s blood sugar and despite upping the constant glucose drips, he is still getting lower readings


MG was surprised said ‘it was quite a shock —I didn’t expect it would it have fallen even lower”


@3:30 doctors upped glucose drip level once again and a larger blood sample was taken and sent off to Liverpool for specialist testing


This^^^ Liverpool test is central to prosecution case and we will be returning to it later for sure


MG and LL were putting together a NEW bag of the glucose drip for baby L, when they were forced to stop what they were doing because baby M’s monitor was beeping for an emergency just before 4 pm.


---around 4 pm, Baby M had suddenly collapsed and stopped breathing


MG: “LL was with me and his alarm went and she went to check and said yes, he needs help we need to sort it out”


[ I think MG and LL were together by that med station/refrigerator which is in room 1, essentially, putting together that new glucose bag—so LL would just have to hurry a few steps away to get to baby M’s cot]


[Also, just before baby M collapsed at 4 , MG would have been busy conferring with the doctors about baby L’s drop in blood sugar around 3:30—and his new blood test to be drawn up and sent out—— LL had 2 babies in the same room, so while MG was busy LL had easy access to baby M]


The jury is shown a picture of the refrigerator where MG and LL are working together at the time M’s alarm goes off.


And they are reminded that all the nurses have access to the refrigerator keys at any time


After baby M’s collapse, LL goes back to looking after her 2 babies in room 1.


And she receives the text from Mum telling her she won her horse bet for 135 pounds


Despite the increased glucose, L’s sugar remained persistently low/Prosecution accuses LL of injected insulin to the glucose drip to try and kill him


After LL left that night she had a couple of days off. April 10th- A new doctor took over care of baby L, and it was this doctor that caused an emotional reaction from LL in court


On the 10th, under this doctor’s care, Baby L recovered and his sugars stabilised


Dr John Gibbs received test April 14th—and entered it into the file—but he didn’t realise the importance of the test and didn’t yet understand that it meant that the child had been injected with synthetic insulin—it was not his natural body’s reaction shown in that test result

Baby L had not been prescribed insulin. Just like with Baby F …who also received mysterious injection

Defense denies the murder attempt

Meyer says 'there is nothing surprising about such a preterm low weight baby having such low blood sugar, as it is common'

'Nothing to show it was LL'

[ Meyers claims there is nothing to show it was LL---but there are only a couple of people that were working in room 1----so it is narrowed down to LL, MG or the 3rd nurse. Problem for LL is that those other 2 were not around during some of the other incidents, whereas LL was. ]

Bolded part is a huge failing of a medical provider and shows the level of care and training they had - not nearly enough. The only reason you get a c-peptide and insulin is to figure out why there's hypoglycemia and to not act on it is honestly inconceivable to me.

Edited to make it clear what part I was referring to: "Dr John Gibbs received test April 14th—and entered it into the file—but he didn’t realise the importance of the test and didn’t yet understand that it meant that the child had been injected with synthetic insulin—it was not his natural body’s reaction shown in that test result"

 

[marynnu]

So - if LL caused AE's in babies, might she not have researched how to do it, and what the effects might be? eg maybe she even found the exact same article which Dr J did? So, wouldn't any searching which LL may have done leave a trail in her computer? Has her computer been thoroughly examined for searches? Has she acquired a new computer since then? My apologies if this has already been discussed.

Every nurse knows the dangers of air embolism, IMO. So an internet search isn't really necessary.

 

[katydid23]

dbm

 

[Parker Knoll]

I have always thought that BUT what about textbooks - wherever she trained would of had a reference library for studies.
Could of been covered in training or AE most certainly would of.

 

[sapphireminds]

which bolded part? Sorry, I am not following.

Sorry, it didn't show up well:
Dr John Gibbs received test April 14th—and entered it into the file—but he didn’t realise the importance of the test and didn’t yet understand that it meant that the child had been injected with synthetic insulin—it was not his natural body’s reaction shown in that test result

 

[katydid23]

So - if LL caused AE's in babies, might she not have researched how to do it, and what the effects might be? eg maybe she even found the exact same article which Dr J did? So, wouldn't any searching which LL may have done leave a trail in her computer? Has her computer been thoroughly examined for searches? Has she acquired a new computer since then? My apologies if this has already been discussed.

I just watched a show on ID Channel about a male nurse, Will Davis, who killed 4 patients by injecting air into their arterial lines.

He was caught when they became suspicious and got warrant to search his home and he hands previously researched air embolisms on google, asking lots of questions about how they work etc.

 

[marynnu]

I have always thought that BUT what about textbooks - wherever she trained would of had a reference library for studies.
Could of been covered in training or AE most certainly would of.

Well, as we've seen many times, neonatal nurses (all nurses, in fact) are obsessive about excluding all air from infusion lines. Even the tiny bit in the ports used to give drugs is flushed out. IMO they know it's dangerous just from this alone. I don't see why LL would have needed to research it at all.

 

[katydid23]

Sorry, it didn't show up well:
Dr John Gibbs received test April 14th—and entered it into the file—but he didn’t realise the importance of the test and didn’t yet understand that it meant that the child had been injected with synthetic insulin—it was not his natural body’s reaction shown in that test result

That was my summarising the podcast---it might not be entirely word for word, as it is paraphrased by me. I can't type every sentence in the entire podcast so I was giving a summary.

That part is probably about 16 minutes in if you want to jump to that and see if I paraphrased accurately?

 

[marynnu]

Sorry, it didn't show up well:
Dr John Gibbs received test April 14th—and entered it into the file—but he didn’t realise the importance of the test and didn’t yet understand that it meant that the child had been injected with synthetic insulin—it was not his natural body’s reaction shown in that test result

I agree this should have been picked up. But in the end it changes nothing about LL's guilt or innocence, IMO.

 

[Kemug]

Every nurse knows the dangers of air embolism, IMO. So an internet search isn't really necessary.

I really meant the fine details of it, particularly what signs and symptoms might occur. And if, for example, it might be possible to cause an AE in such a manner that the usual signs and symptoms might be minimized. IANAD, so this is just an idea.

 

[Marantz4250b]

I agree this should have been picked up. But in the end it changes nothing about LL's guilt or innocence, IMO.

I tend to agree. However, if so much seems to be being filed away or thought not important enough to investigate or even to record in notes (the blotching) doesn't it somewhat undermine the importance of the evidence and the accuracy of those giving it?

It's easy to see things in hindsight and possibly attribute things to them that you later see as "fitting" with a particular cause when, in fact, they don't.

 

[katydid23]

It would be a very good idea for mr Myers to ask mg if she saw or heard LL attending to baby M at any point in the five minutes preceding the collapse. Would I be assuming correctly that the lines through which the alleged AE would have to have gone through is on the outside of the incubator?

assuming this is the same one that is used to administer drugs to bypass the monitor.

Can you think of any reason that a non dn would have to be fiddling with lines when the dn is there? Especially when the dn is presumably senior to LL with that much experience and being older.

these are assumptions but mg seems to have a good recall of events that day. I struggle to think she wouldn’t remember LL being in proximity to child M in the necessary time frame or that she wasn’t present in the room for say 5 mins prior to the right time ie on the computer. Giving LL scope to do it while no one else is present.

it’s a shame we don’t have her testimony or notes of observations taken immediately prior to the collapse. From 3.55 to 4 pm. we don’t even know what LL was doing ie tending to her designated child.

im also wondering if an ai would cause physical pain to a baby in the time the bubble is travelling in the body? Presumably if that was at most 3 mins? Of travel during which the baby is in pain there would have been signs from the baby M like crying?

it seems like baby m just crashed like a light switch going off.

The podcast I just posted about a few posts upthread, answers those questions for you.

Baby L and M were in room 1, along with 2 other babies who were designated patients of Nurse Letrby.

So LL and MG were the 2 designated nurses for the 4 babies in room 1. And according to the podcast, they were sharing the loads with each other.

LL would be in and about that same room all shift long, with no one wondering why. She had total access to L and M and the timeline in the podcast shows she had a nice window of time to be alone with baby M while MG was conferring with the doctors about baby L's blood sugar issues at around 3:30. They gave her some new orders for meds and asked her to send out a blood test afterwards. That would keep her busy and then at 4 pm Baby M had a sudden collapse.

UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #11

Can you explain to me where you are going with this line of questioning? I'm going disclaim once again that I have not undergone the verified expert process, therefore you should not regard anything I have to say as anything but my opinion. Back in 1989, without surfactant, preemie lungs...

www.websleuths.com

 

[sapphireminds]

I agree this should have been picked up. But in the end it changes nothing about LL's guilt or innocence, IMO.

I think it is showing that there could have been some sort of accidental administration or error, especially considering that the hypoglycemia continued despite changing fluids.

If the unit is so chaotic that they don't know basic medical information, it decreases my trust in their ability to assess anything.

 

[Parker Knoll]

Well, as we've seen many times, neonatal nurses (all nurses, in fact) are obsessive about excluding all air from infusion lines. Even the tiny bit in the ports used to give drugs is flushed out. IMO they know it's dangerous just from this alone. I don't see why LL would have needed to research it at all.

Exactly.

 

[marynnu]

I think it is showing that there could have been some sort of accidental administration or error, especially considering that the hypoglycemia continued despite changing fluids.

If the unit is so chaotic that they don't know basic medical information, it decreases my trust in their ability to assess anything.

One thing that is certain IMO is that this was no error. The fluids were changed by LL and the designated nurse to no effect, but the change overnight resolved the problem. Either way, someone administered a large dose of insulin to this child. The only question is who.